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Fertility and Sterility Dec 2013To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of blastocyst-stage and... (Meta-Analysis)
Meta-Analysis Review
Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of blastocyst-stage versus cleavage-stage embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis.
OBJECTIVE
To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of blastocyst-stage and cleavage-stage embryos generated through IVF.
DESIGN
Systematic review.
SETTING
University hospital.
PATIENT(S)
Singleton pregnancies resulting from ET at the blastocyst stage versus those at the cleavage stage.
INTERVENTION(S)
Medline, EMBASE, Cochrane Central Register of Clinical Trials DARE, and CINAHL (1980-2013) were searched. Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using CASP scoring. Risk ratios and risk differences were calculated in Rev Man 5.1.
MAIN OUTCOME MEASURE(S)
Very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, congenital anomalies, perinatal mortality, preeclampsia, and placenta previa.
RESULT(S)
In vitro fertilization pregnancies occurring as a result of ET at the blastocyst stage were associated with a higher relative risk (RR; 95% confidence interval [CI]) of preterm (RR 1.27; 95% CI 1.22-1.31) and very preterm delivery (RR 1.22; 95% CI 1.10-1.35) in comparison with those resulting from the transfer of cleavage-stage embryos. The risk of growth restriction was lower in babies conceived through blastocyst transfer (RR 0.82; 95% CI 0.77-0.88).
CONCLUSION(S)
Data from observational studies show that ET at the blastocyst stage is associated with a higher risk of very preterm delivery. However, we were not able to adjust for confounders. Perinatal outcome data from existing randomized trials are needed to determine the safety of ET at the blastocyst stage compared with the cleavage stage.
Topics: Blastocyst; Cleavage Stage, Ovum; Comorbidity; Embryo Transfer; Female; Fertilization in Vitro; Humans; Incidence; Infant, Low Birth Weight; Infertility, Female; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Survival Rate; Treatment Outcome
PubMed: 24083875
DOI: 10.1016/j.fertnstert.2013.08.044 -
Reproduction (Cambridge, England) Apr 2022Genetic testing is becoming increasingly required at almost every stage of failed female reproduction/infertility. Nonetheless, clinical evidence for the majority of...
Genetic testing is becoming increasingly required at almost every stage of failed female reproduction/infertility. Nonetheless, clinical evidence for the majority of identified gene-disease relationships is ill-defined, thus leading to difficult gene variant interpretation and poor translation of existing knowledge into clinics. We aimed to identify the genes that have ever been implicated in monogenic female reproductive failure in humans and to classify the identified gene-disease relationship pairs using a standardized clinical validity assessment. A PubMed search following PRISMA guidelines was conducted on 20 September 2021 aiming to identify studies pertaining to genetic causes of phenotypes of female reproductive failure. The clinical validity of identified gene-disease pairs was assessed using standardized criteria, counting whether sufficient genetic and experimental evidence has been accumulated to consider a single gene 'characterized' for a single Mendelian disease. In total, 1256 articles were selected for the data extraction; 183 unique gene-disease pairs were classified spanning the following phenotypes: hypogonadotropic hypogonadism, ovarian dysgenesis, premature ovarian failure/insufficiency, ovarian hyperstimulation syndrome, empty follicle syndrome, oocyte maturation defect, fertilization failure, early embryonic arrest, recurrent hydatidiform mole, adrenal disfunction and Mullerian aplasia. Twenty-four gene-disease pairs showed definitive evidence, 36 - strong, 19 - moderate, 81 - limited and 23 - showed no evidence. Here, we provide comprehensive, systematic and timely information on the genetic causes of female infertility. Our classification of genetic causes of female reproductive failure will facilitate the composition of up-to-date guidelines on genetic testing in female reproduction, the development of diagnostic gene panels and the advancement of reproductive decision-making.
Topics: Female; Genetic Testing; Humans; Infertility, Female; Neoplasm Recurrence, Local; Oocytes; Ovarian Hyperstimulation Syndrome; Pregnancy
PubMed: 35451369
DOI: 10.1530/REP-21-0486 -
Human Reproduction Update 2013BACKGROUND Conflicting results have been reported regarding the technique of brief insemination used in IVF. The aim of this meta-analysis was to determine if better... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND Conflicting results have been reported regarding the technique of brief insemination used in IVF. The aim of this meta-analysis was to determine if better clinical outcomes of IVF are associated with a brief co-incubation of gametes than with a standard overnight co-incubation. METHODS A computerized search was conducted of the published literature of four databases, using search terms related to gamete, time of co-incubation and outcome measure. Eligible studies compared outcomes of IVF with a brief co-incubation of gametes to that of a control group of standard insemination and reported rates of live birth (primary outcome), normal fertilization, polyspermy, good quality embryos, implantation, clinical pregnancy or ongoing pregnancy (secondary outcomes). A total of 11 studies were included in the meta-analysis. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for the data. Statistical heterogeneity was tested using Cochran Q and I² values. RESULTS Brief co-incubation of gametes was associated with significantly higher rates of clinical pregnancy (RR: 1.84, 95% CI: 1.24-2.73) and ongoing pregnancy (RR: 1.73, 95% CI: 1.27-2.33) than standard insemination. Brief co-incubation of gametes was associated also with a significantly higher rate of implantation (RR: 1.80, 95% CI: 1.43-2.26) than standard insemination. However, the rates of normal fertilization (RR: 0.98, 95% CI: 0.93-1.02), good quality embryos (RR: 1.24, 95% CI: 1.0-1.53) and polyspermy (RR: 0.84, 95% CI: 0.7-1.01) were not significantly different with brief co-incubation of gametes compared with standard insemination. CONCLUSIONS Reduced gamete exposure time may be associated with beneficial outcomes. Drawbacks inherent to the quality of several studies limit the quality of the available evidence. Adequately powered randomized controlled studies need to be performed to evaluate the efficacy of brief insemination.
Topics: Coculture Techniques; Embryo Implantation; Female; Fertilization in Vitro; Humans; Insemination; Live Birth; Male; Ovum; Pregnancy; Pregnancy Rate; Spermatozoa; Time Factors
PubMed: 23912477
DOI: 10.1093/humupd/dmt036 -
JBRA Assisted Reproduction Mar 2023The aim of this study is to analyze the efficacy of the dual trigger (human chorionic gonadotropin (hCG) + GnRH agonists) compared to the conventional trigger (hCG) in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this study is to analyze the efficacy of the dual trigger (human chorionic gonadotropin (hCG) + GnRH agonists) compared to the conventional trigger (hCG) in terms of oocyte retrieval (number and oocyte maturity), fertilization rate or number of embryos with two pronuclei, number of high-quality embryos, number of transferred embryos, number of cryopreserved embryos, implantation rate, positive β-hCG rate, ongoing pregnancy rate, abortion rate, and live birth rate.
METHODS
This search performed in this systematic review included all literature published in the PubMed database of studies on controlled ovarian stimulation with dual trigger compared with conventional trigger. The meta-analysis included clinical trials and prospective cohort studies.
RESULTS
Statistically significant differences between groups (dual trigger vs. hCG trigger) in terms of number of oocytes retrieved and live birth rate favored the dual trigger protocol. No statistically significant differences were found in the other studied variables. A tend favoring the dual trigger protocol was observed in all studied parameters.
CONCLUSIONS
Dual trigger seems to be more effective in GnRH antagonist cycles in terms of embryo and pregnancy outcome.
Topics: Female; Pregnancy; Humans; Sperm Injections, Intracytoplasmic; Prospective Studies; Ovulation Induction; Gonadotropin-Releasing Hormone; Fertilization in Vitro; Oocytes; Chorionic Gonadotropin; Retrospective Studies
PubMed: 36356171
DOI: 10.5935/1518-0557.20220035 -
Human Reproduction Update 2011Assisted hatching (AH) is a manipulation of zona pellucida aiming to facilitate embryo implantation. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Assisted hatching (AH) is a manipulation of zona pellucida aiming to facilitate embryo implantation.
METHODS
Systematic review and meta-analysis of medical literature was used to evaluate the effect of AH on assisted reproduction outcomes: clinical pregnancy, live birth, multiple pregnancy and miscarriage. Additional analysis was performed in these subgroups: (i) fresh embryos transferred to unselected or non-poor prognosis women; (ii) fresh embryos transferred to women with previous repeated failure; (iii) fresh embryos transferred to women of advanced age; (iv) frozen-thawed embryos transferred to unselected or non-poor prognosis women. Analyses were based on risk ratio and 95% confidence intervals (RR, 95% CIs) using Mantel-Haenszel random effects model.
RESULTS
There were 28 studies (5507 participants) included. AH was related to a trend toward increased clinical pregnancy for all participants (RR = 1.11, 95% CI = 1.00-1.24), with a significant increase in subgroups 2 (RR = 1.73; 95% CI = 1.37-2.17) and 4 (RR = 1.36; 95% CI = 1.08-1.72, P< 0.01), but not for subgroups 1 and 3. For multiple pregnancy, a significant increase was observed for all participants (RR = 1.45; 95% CI = 1.11-1.90) and for subgroups 2 (RR = 2.53; 95% CI = 1.23-5.21) and 4 (RR = 3.40; 95% CI = 1.93-6.01). No significant heterogeneity was observed in subgroup analysis.
CONCLUSIONS
AH was related to increased clinical pregnancy and multiple pregnancy rates in women with previous repeated failure or frozen-thawed embryos. However, AH is unlikely to increase clinical pregnancy rates when performed in fresh embryos transferred to unselected or non-poor prognosis women or to women of advanced age. Due to the small sample evaluated by the pool of included studies, no proper conclusions could be drawn regarding miscarriage or live birth.
Topics: Abortion, Spontaneous; Adult; Embryo Implantation; Embryo Transfer; Female; Humans; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Pregnancy, Multiple; Randomized Controlled Trials as Topic; Zona Pellucida
PubMed: 21474527
DOI: 10.1093/humupd/dmr012 -
Fertility and Sterility Aug 2011To perform a systematic review of the literature to identify randomized controlled trials assessing the efficacy of oocyte vitrification in terms of oocyte survival,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a systematic review of the literature to identify randomized controlled trials assessing the efficacy of oocyte vitrification in terms of oocyte survival, fertilization, embryo development, and pregnancy rates.
DESIGN
Systematic review and meta-analysis of randomized controlled trials.
SETTING
Private university-affiliated IVF center, university-based hospital.
PATIENT(S)
Patients recruited in randomized controlled trials considering oocyte vitrification as one of the experimental arms and slow freezing or fresh oocytes control as the other.
INTERVENTION(S)
Vitrification of human oocytes vs. slow freezing or fresh oocytes.
MAIN OUTCOME MEASURE(S)
Ongoing pregnancy rate; secondary outcomes were clinical pregnancy rate, implantation rate, embryo development, fertilization rate, and oocyte survival.
RESULT(S)
Five eligible studies were finally included. They involved 4,282 vitrified oocytes, 3,524 fresh oocytes, and 361 slow-frozen oocytes between 2005 and 2009. The rates of ongoing pregnancy, top-quality embryo, embryo cleavage, and fertilization did not differ between the vitrification and the fresh oocyte groups. The oocyte survival rate was higher in vitrified vs. slow-frozen oocytes (odds ratio [OR] 2.46, 95% confidence interval [CI] 1.82-3.32), although heterogeneity between studies was observed. The fertilization rate was higher in vitrified vs. slow-frozen oocytes (OR 1.50, 95% CI 1.07-2.11). Vitrification also resulted in a higher rate top-quality embryo (22.4% vs. 8.0%, OR 3.32, 95% CI 1.37-8.02) and embryo cleavage rate (day 2: 64.6% vs. 47.7%, OR 2.00, 95% CI 1.33-3.00; day 3: 53.0% vs. 33.3%, OR 2.25, 95% CI 1.32-3.85) as compared with slow freezing.
CONCLUSION(S)
Vitrification is an efficient method to preserve oocytes, although more large controlled clinical trials are needed to strengthen this conclusion.
Topics: Cell Survival; Cryopreservation; Embryo Transfer; Evidence-Based Medicine; Female; Fertility; Fertilization in Vitro; Humans; Infertility; Odds Ratio; Oocytes; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic; Reproductive Techniques, Assisted; Risk Assessment; Risk Factors; Treatment Outcome; Vitrification
PubMed: 21718983
DOI: 10.1016/j.fertnstert.2011.06.030 -
Reproductive Sciences (Thousand Oaks,... Dec 2012The possible adverse effects of organochlorine pollutants (OPs) on human fertility are a matter of concern. Direct evaluation of the effects on female fertility was made... (Review)
Review
The possible adverse effects of organochlorine pollutants (OPs) on human fertility are a matter of concern. Direct evaluation of the effects on female fertility was made possible by the advent of in vitro fertilization (IVF). We conducted a systematic review to assess possible associations between OP levels and selected indicators of female fertility in the context of IVF. After harmonization, OP concentrations per unit of lipid varied considerably, OP concentrations were higher in follicular than in serum and conflicting results were obtained. No significant adverse association between OP concentration and female fertility was observed in some studies. In other reports, there were indications of various degrees of significance that oocyte, embryo quality, and implantation may have been impaired. Thus, this review provides no evidence to support the hypothesis that OPs impair female fertility but insufficient evidence to reject this hypothesis. Our conclusions are limited by the diversity of the protocols used, OPs studied, and the quality of the studies selected. The IVF provides a unique context in which to assess the impact of OPs on female fertility, but it is subject to several limitations. Potential frameworks for future studies are proposed.
Topics: Embryo Implantation; Embryo Transfer; Embryo, Mammalian; Environmental Pollutants; Female; Fertilization in Vitro; Follicular Fluid; Humans; Hydrocarbons, Chlorinated; Infertility, Female; MEDLINE; Oocytes; Pesticides; Pregnancy
PubMed: 22593147
DOI: 10.1177/1933719112446077 -
Human Reproduction Update Apr 2021Delayed parenthood, by both women and men, has become more common in developed countries. The adverse effect of advanced maternal age on embryo aneuploidy and... (Meta-Analysis)
Meta-Analysis
Is there an association between paternal age and aneuploidy? Evidence from young donor oocyte-derived embryos: a systematic review and individual patient data meta-analysis.
BACKGROUND
Delayed parenthood, by both women and men, has become more common in developed countries. The adverse effect of advanced maternal age on embryo aneuploidy and reproductive outcomes is well known. However, whether there is an association between paternal age (PA) and embryonic chromosomal aberrations remains controversial. Oocyte donation (OD) is often utilized to minimize maternal age effects on oocyte and embryo aneuploidy, thus providing an optimal model to assess the effect of PA. Several studies have revealed a higher than expected rate of aneuploidy in embryos derived from young oocyte donors, which warrants examination as to whether this may be attributed to advanced PA (APA).
OBJECTIVE AND RATIONALE
The objective of this systematic review and individual patient data (IPD) meta-analysis is to evaluate existing evidence regarding an association between PA and chromosomal aberrations in an OD model.
SEARCH METHODS
This review was conducted according to PRISMA guidelines for systematic reviews and meta-analyses. Medline, Embase and Cochrane databases were searched from inception through March 2020 using the (MeSH) terms: chromosome aberrations, preimplantation genetic screening and IVF. Original research articles, reporting on the types and/or frequency of chromosomal aberrations in embryos derived from donor oocytes, including data regarding PA, were included. Studies reporting results of IVF cycles using only autologous oocytes were excluded. Quality appraisal of included studies was conducted independently by two reviewers using a modified Newcastle-Ottawa Assessment Scale. A one-stage IPD meta-analysis was performed to evaluate whether an association exists between PA and aneuploidy. Meta-analysis was performed using a generalized linear mixed model to account for clustering of embryos within patients and clustering of patients within studies.
OUTCOMES
The search identified 13 032 references, independently screened by 2 reviewers, yielding 6 studies encompassing a total of 2637 IVF-OD cycles (n = 20 024 embryos). Two 'low' quality studies using FISH to screen 12 chromosomes on Day 3 embryos (n = 649) reported higher total aneuploidy rates and specifically higher rates of trisomy 21, 18 and 13 in men ≥50 years. One 'moderate' and three 'high' quality studies, which used 24-chromosome screening, found no association between PA and aneuploidy in Day 5/6 embryos (n = 12 559). The IPD meta-analysis, which included three 'high' quality studies (n = 10 830 Day 5/6 embryos), found no significant effect of PA on the rate of aneuploidy (odds ratio (OR) 0.97 per decade of age, 95% CI 0.91-1.03), which was robust to sensitivity analyses. There was no association between PA and individual chromosome aneuploidy or segmental aberrations, including for chromosomes X and Y (OR 1.06 per decade of age, 95% CI 0.92-1.21). Monosomy was most frequent for chromosome 16 (217/10802, 2.01%, 95% CI 1.76-2.29%) and trisomy was also most frequent for chromosome 16 (194/10802, 1.80%, 95% CI 1.56-2.06%).
WIDER IMPLICATIONS
We conclude, based on the available evidence, that APA is not associated with higher rates of aneuploidy in embryos derived from OD. These results will help fertility practitioners when providing preconception counselling, particularly to older men who desire to have a child.
Topics: Aged; Aneuploidy; Female; Fertilization in Vitro; Humans; Male; Oocyte Donation; Oocytes; Paternal Age; Pregnancy; Preimplantation Diagnosis
PubMed: 33355342
DOI: 10.1093/humupd/dmaa052 -
Journal of Assisted Reproduction and... Jul 2016The objective of this meta-analysis is to determine whether there is a higher incidence of preeclampsia (PE) in pregnancies achieved by oocyte donation (OD) compared... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The objective of this meta-analysis is to determine whether there is a higher incidence of preeclampsia (PE) in pregnancies achieved by oocyte donation (OD) compared with pregnancies achieved by in vitro fertilization with autologous oocytes (IVF).
METHODS
A systematic review was performed to identify relevant studies published from January 1994 until April 2015 with at least an abstract in English using PubMed, ISI Web of Knowledge, and clinicaltrials.gov. The 11 studies included in this systematic review were retrospective and prospective cohort studies of women reporting results on the association between oocyte donation vs. in vitro fertilization (exposure) and preeclampsia (outcome).
RESULTS
Oocyte donation is a risk factor for the development of PE compared to IVF cycles, with a weighted OR of 3.12 under a fixed effects method (FEM: no heterogeneity between the studies). The weighted OR under a random effects model was 2.9 (REM: heterogeneity between the studies). The meta-regression analysis showed that neither multiple pregnancies (estimate = 0.08; p = 0.19) nor patient age (estimate = -2.29; p = 0.13) significantly explained the variability of the effect of oocyte donation on PE. Q statistic was 12.78 (p = 0.237), suggesting absence of heterogeneity between the studies.
CONCLUSIONS
Pregnancies achieved by oocyte donation confer a threefold increase in the likelihood of developing PE than those achieved by in vitro fertilization with own oocytes. Physicians should be aware of this risk in order to both counsel patients and monitor pregnancies accordingly.
Topics: Female; Fertilization in Vitro; Humans; Oocyte Donation; Oocytes; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Retrospective Studies; Risk Factors
PubMed: 27007875
DOI: 10.1007/s10815-016-0701-9 -
International Journal of Molecular... Apr 2022Gamete membrane fusion is a critical cellular event in sexual reproduction. In addition, the generation of knockout models has provided a powerful tool for testing the... (Review)
Review
Gamete membrane fusion is a critical cellular event in sexual reproduction. In addition, the generation of knockout models has provided a powerful tool for testing the functional relevance of proteins thought to be involved in mammalian fertilization, suggesting IZUMO1 and TMEM95 (transmembrane protein 95) as essential proteins. However, the molecular mechanisms underlying the process remain largely unknown. Therefore, the aim of this study was to summarize the current knowledge about IZUMO1 and TMEM95 during mammalian fertilization. Hence, three distinct databases were consulted-PubMed, Scopus and Web of Science-using single keywords. As a result, a total of 429 articles were identified. Based on both inclusion and exclusion criteria, the final number of articles included in this study was 103. The results showed that IZUMO1 is mostly studied in rodents whereas TMEM95 is studied primarily in bovines. Despite the research, the topological localization of IZUMO1 remains controversial. IZUMO1 may be involved in organizing or stabilizing a multiprotein complex essential for the membrane fusion in which TMEM95 could act as a fusogen due to its possible interaction with IZUMO1. Overall, the expression of these two proteins is not sufficient for sperm-oocyte fusion; therefore, other molecules must be involved in the membrane fusion process.
Topics: Animals; Cattle; Fertilization; Immunoglobulins; Male; Mammals; Membrane Proteins; Sperm-Ovum Interactions; Spermatozoa
PubMed: 35409288
DOI: 10.3390/ijms23073929